What is the differential diagnosis for erythema marginatum (a rash associated with acute rheumatic fever)?

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Last updated: April 26, 2025 • View editorial policy

Differential Diagnosis for Erythema Marginatum

  • Single most likely diagnosis + Acute Rheumatic Fever: This is the most common association with erythema marginatum, a characteristic rash that appears as a pink ring on the skin, often seen in the context of acute rheumatic fever following a group A beta-hemolytic streptococcal infection.
  • Other Likely diagnoses + Infectious Endocarditis: Although less common, infectious endocarditis can present with a variety of skin manifestations, including erythema marginatum-like lesions, especially in the context of certain bacterial infections. + Autoimmune Disorders (e.g., Lupus): Some autoimmune conditions can cause skin rashes that might resemble erythema marginatum, though the clinical context and other symptoms would typically distinguish these.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Meningococcemia: This condition, caused by Neisseria meningitidis, can present with a rash that might be confused with erythema marginatum. It's critical to consider this diagnosis due to its high mortality rate if not promptly treated. + Rocky Mountain Spotted Fever: Another infectious disease that can cause a rash, though it typically has a distinct distribution and is accompanied by other symptoms like fever and headache.
  • Rare diagnoses + Secondary Syphilis: Can cause a wide range of skin manifestations, including rashes that might be mistaken for erythema marginatum, though other symptoms and diagnostic tests would help differentiate. + Erythema Multiforme: A skin condition characterized by target lesions, which might be considered in the differential for erythema marginatum, especially if the presentation is atypical.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.